【痰壅之症】身热神昏，声如 睡，喘急不宁，语言不便，此外感痰壅之症也。
【痰壅之因】肺胃有热，外束风邪，热无从泄，则为喘为 ，而痰涎壅盛矣。
【痰壅之脉】脉多浮大，浮紧风寒，浮数风热，沉滑顽痰，洪滑痰热。寸口脉大，肺
【痰壅之治】风寒者，加减桂枝汤；风热者，加减防风汤；痰热者，栀连二陈汤；顽
痰者，导痰汤；肺壅痰喘，加减泻白散。
加减防风汤
防风 荆芥 桔梗 甘草 薄荷 天花粉 半夏 连翘 山栀 黄芩 栝蒌仁
加减桂枝汤
桂枝 麻黄 杏仁 半夏 生姜 甘草
栀连二陈汤
陈皮 半夏 白茯苓 甘草 山栀 川黄连
导痰汤
南星 半夏 橘红 甘草 枳壳 石菖蒲
加减泻白散 痰结上焦，先用吐法。
桑白皮 地骨皮 甘草
风，加防风、荆芥；寒，加麻黄、桂枝。
【痰壅之症】身无寒热，痰结心胸，上气喘逆，喉中有声。此内伤痰壅之症也。
【痰壅之因】或膏粱嗜酒，内热生痰；或饮食过饱，停留作患；或忧思郁结，五志火
动；或脾气虚损，不能运化，则内伤痰壅之症作矣。
【痰壅之脉】脉多滑大，滑数积热，沉实食凝，沉滑抑遏，洪数火多，缓大脾怯。
汤、
仁；脾虚不能运化，六君子汤。
胆星汤 见中风。
栀连二陈汤 见胸痛。
加味泻白散 见胸痛。
导痰汤 见半身不遂。
三化汤 见中风。
滚痰丸 见痰积腹痛。
六君子汤
人参 白术 茯苓 甘草 半夏 广皮
痰有虚实，若脾胃虚，不能运化水谷而成者，为虚痰。肠胃湿热，蒸酿水谷而成者，为
实痰。痰壅之症，以其壅闭经络，迷塞中焦而命名，则痰壅当为实症。然脾胃虚不能运化者
，间而亦有，但实痰壅闭者易治，不过消之散之而已；虚而停滞者，补之不服，逐之愈虚故
也。然实痰壅塞，亦有各条分别，如发热神昏，六脉浮数，痰涎壅结，气急喘鸣，当外解表
邪；无汗者，加减羌活汤、导痰消滞汤；有汗者，加减防风合涤痰汤。若外无发热，神气不
昏，六脉沉滑者，则用导痰消滞汤，调家秘保和散；若大便不通者，当以导痰消滞汤加玄明
粉下之；若见咳嗽喘逆，此肺气受病，当用节斋化痰丸、三子养亲汤，合泻白枳桔汤等；若
肺有表邪，当用羌活泻白散、防风泻白散。
[Symptoms of Phlegm Obstruction] The body is hot, consciousness is clouded, the voice sounds like snoring during sleep, breathing is rapid and restless, and speech is difficult. These are the symptoms of phlegm obstruction caused by external contraction.
[Etiology of Phlegm Obstruction] Heat in the Lung and Stomach, combined with external wind pathogen binding the exterior, prevents heat from dissipating. This leads to panting, stridor (abnormal respiratory sound), and excessive accumulation of phlegm and saliva.
[Pulse of Phlegm Obstruction] The pulse is mostly floating and large. A floating-tight pulse indicates Wind-Cold; a floating-rapid pulse indicates Wind-Heat; a deep-slippery pulse indicates stubborn phlegm; a surging-slippery pulse indicates Phlegm-Heat. A large pulse at the Cun Kou position indicates Lung Qi obstruction.
[Treatment of Phlegm Obstruction] For cases due to Wind-Cold, use Modified Guizhi Tang (Cinnamon Twig Decoction); for cases due to Wind-Heat, use Modified Fangfeng Tang (Saposhnikovia Decoction); for cases due to Phlegm-Heat, use Zhilian Erchen Tang (Gardenia and Coptis Two-Chen Decoction); for cases due to Stubborn Phlegm, use Daotan Tang (Phlegm-Guiding Decoction); for Lung obstruction with phlegm and panting, use Modified Xiebai San (Modified White Powder to Drain).
Modified Fangfeng Tang
Fangfeng (Radix Saposhnikoviae), Jingjie (Fructus Schizonepetae), Jiegeng (Radix Platycodonis), Gancao (Radix Glycyrrhizae), Bohe (Herba Menthae), Tianhuafen (Radix Trichosanthis), Banxia (Rhizoma Pinelliae), Lianqiao (Fructus Forsythiae), Shanzhi (Fructus Gardeniae), Huangqin (Radix Scutellariae), Gualouren (Semen Trichosanthis).
Modified Guizhi Tang
Guizhi (Ramulus Cinnamomi), Mahuang (Herba Ephedrae), Xingren (Semen Prunus Armeniacae), Banxia (Rhizoma Pinelliae), Shengjiang (Rhizoma Zingiberis Recens), Gancao (Radix Glycyrrhizae).
Zhilian Erchen Tang
Chenpi (Pericarpium Citri Reticulatae), Banxia (Rhizoma Pinelliae), Baifuling (Poria cum Radice Pini et Ligno Quercus), Gancao (Radix Glycyrrhizae), Shanzhi (Fructus Gardeniae), Chuanhuilian (Rhizoma Coptidis).
Daotan Tang
Nanxing (Rhizoma Arisaematis Cum Bile), Banxia (Rhizoma Pinelliae), Juhong (Exocarpium Citri Reticulatae Viride), Gancao (Radix Glycyrrhizae), Zhike (Fructus Aurantii), Shichangpu (Rhizoma Acori Tatarinowii).
Modified Xiebai San
If phlegm knots in the Upper Jiao, first employ the emetic method.
Sangbaipi (Cortex Mori Radicis), Digupi (Cortex Lycii Radicis), Gancao (Radix Glycyrrhizae).
If Wind is present, add Fangfeng (Radix Saposhnikoviae) and Jingjie (Fructus Schizonepetae); if Cold is present, add Mahuang (Herba Ephedrae) and Guizhi (Ramulus Cinnamomi).
[Symptoms of Internal Injury Phlegm Obstruction] The body has no chills or fever, phlegm knots in the Heart and Chest region, leading to upward rushing panting and audible sounds in the throat. These are the symptoms of phlegm obstruction caused by internal injury.
[Etiology of Internal Injury Phlegm Obstruction] It may be caused by indulgence in rich food and alcohol, generating internal heat and phlegm; or by overeating, causing stagnation and disease; or by worry and thought leading to depression, stirring up the Fire of the Five Emotions; or by deficiency of Spleen Qi, failing to transform and transport, thereby producing symptoms of internal injury phlegm obstruction.
[Pulse of Internal Injury Phlegm Obstruction] The pulse is mostly slippery and large. A slippery-rapid pulse indicates accumulated heat; a deep-solid pulse indicates food stagnation; a deep-slippery pulse indicates suppression and obstruction; a surging-rapid pulse indicates excess fire; a slow-large pulse indicates Spleen weakness.
For Spleen deficiency failing to transform and transport, use Liujunzi Tang (Six-Gentlemen Decoction).
Dansheng Tang (Arisaema with Bile Decoction) (See Stroke chapter).
Zhilian Erchen Tang (Gardenia and Coptis Two-Chen Decoction) (See Chest Pain chapter).
Jiawei Xiebai San (Addition-Flavor White Powder to Drain) (See Chest Pain chapter).
Daotan Tang (Phlegm-Guiding Decoction) (See Hemiplegia chapter).
Sanhua Tang (Three-Transformations Decoction) (See Stroke chapter).
Gun Tan Wan (Rolling Phlegm Pill) (See Abdominal Pain due to Phlegm Accumulation chapter).
Liujunzi Tang (Six-Gentlemen Decoction)
Renshen (Radix Ginseng), Baizhu (Rhizoma Atractylodis Macrocephalae), Fuling (Poria), Gancao (Radix Glycyrrhizae), Banxia (Rhizoma Pinelliae), Guangpi (Pericarpium Citri Reticulatae).
Phlegm patterns have Deficiency and Excess types. If formed due to Spleen-Stomach deficiency failing to transform and transport water and grain, it is called Deficient Phlegm. If formed due to Damp-Heat in the Intestines steaming and fermenting water and grain, it is called Excess Phlegm. The condition named "Phlegm Obstruction" derives its name from blocking meridians and obstructing the Middle Jiao, so Phlegm Obstruction should generally be considered an Excess pattern. However, cases where Spleen-Stomach deficiency fails to transform do occasionally occur. Nevertheless, Excess Phlegm obstruction is easier to treat, requiring only resolution and dispersion; whereas Deficiency stagnation is harder to treat, as tonification may not be tolerated, and purging will further weaken the patient. Regarding Excess Phlegm obstruction, there are specific distinctions:
If accompanied by fever, clouded consciousness, floating-rapid pulses in all six positions, knotted phlegm and saliva, and rapid panting with wheezing, one should first release the exterior pathogen.
If there is no sweating, use Modified Qianghuo Tang (Notopterygium Decoction) or Daotan Xiaozhi Tang (Phlegm-Guiding and Stagnation-Resolving Decoction); if there is sweating, use Modified Fangfeng Tang combined with Ditang Tang (Phlegm-Washing Decoction).
If there is no external fever, consciousness is clear, and pulses are deep-slipper, use Daotan Xiaozhi Tang (Phlegm-Guiding and Stagnation-Resolving Decoction) blended with Jiemi Baohe San (Secret Formula Harmonizing Preservation Powder).
If constipation is present, use Daotan Xiaozhi Tang added with Xuanmingfen (Natrii Sulfas) to purge.
If cough and panting with reversal are seen, indicating Lung pathology, use Jiezai Huatan Wan (Jiezai Resolving-Phlegm Pill) and Sanzi Yangqin Tang (Three-Seed Nourishing-Family Decoction), combined with Xiebai Zhijie Tang (Drain-White and Magnolia Bark Decoction).
If the Lung has exterior pathogens, use Qianghuo Xiebai San (Notopterygium Drain-White Powder) or Fangfeng Xiebai San (Saposhnikovia Drain-White Powder).